Dissociation in posttraumatic stress disorder part I: Definitions and review of research.

Abstract

Since Janet wrote about dissociation in the early 1900s, the relationship between traumatic stress and dissociation has been discussed and debated in the fields of psychology and psychiatry. In the last 25 years, research has been conducted that allows empirical examination of this relationship and the question of how dissociative symptoms are related to posttraumatic stress disorder (PTSD). After defining the types of dissociative experiences that are considered most relevant to PTSD, we present a comprehensive and systematic review of research addressing the relationship between dissociation and traumatic stress; the rise in dissociation after traumatic stress and its subsequent decline over time; the relationship between dissociation and symptoms of PTSD in nonclinical, clinical, and PTSD samples; the conditional probability of high PTSD symptoms when dissociation level is high; the relationships among dissociation and re-experiencing, avoidance, and hyperarousal symptoms of PTSD; and biological studies of disso ciation in PTSD.

Ten reasons for conceiving and classifying posttraumatic stress disorder as a dissociative disorder

“…Cognitive-emotional symptoms are consistently and strongly related to DSM-IV PTSD symptoms (Carlson et al 2012). For example, anger and dissociative symptoms statistically predicted PTSD, hyperarousal, and avoidance/numbing severity, and dissociative symptoms predicted intrusive severity (Kulkarni et al 2012).…”

“…A recent review (Carlson et al 2012) documented that cognitive-emotional dissociative symptoms are moderately related to adverse event exposure and the severity of these events.…”

“…Cognitive-emotional dissociative symptoms can emerge during and following adverse event remain high thereafter (Carlson et al 2012). This peritraumatic dissociation is an important predictor of PTSD (e.g., Baranyi et al 2010;Van der Hart et al 2008).…”

Prediction of Posttraumatic Stress Disorder From Peritraumatic Dissociation and Distress Among Men and Women Victims of Violent Crimes

“…For instance, substantial effect sizes (≈0.40) between PD and posttraumatic symptomatology were reported in a meta analysis (Lensvelt-Mulders et al, 2008), whilst a systematic review including prospective studies on VVC did not show that PD was an independent predictor of PTSD (Van der Velden & Wittmann, 2008). Methodological differences across studies in the type or timing of the measures or in the type of sample investigated may explain some of the inconsistencies observed in the literature (Carlson, Dalenberg, & McDade-Montez, 2012). In sum, meta-analyses (Brewin, Andrews, & Valentine, 2000a;Ozer et al, 2008) emphasize that peritraumatic psychological processes such as the subjective perception of life threat show the strongest risk for PTSD, in comparison to more static factors like age, personality traits or prior exposure.…”

Trauma-related altered states of consciousness in post-traumatic stress disorder patients with or without comorbid dissociative disorders

“…This relationship manifests in both symptomatic overlap and high comorbidity. Patients with PTSD generally experience increased levels of dissociative symptoms compared to trauma-affected people without PTSD (Carlson, Dalenberg, & McDade-Montez, 2012; Dorahy & van der Hart, 2015), while a dissociative subtype of PTSD patients (DPTSD) is characterized by pervasive symptoms of derealization and depersonalization and often related to childhood abuse (Lanius, Brand, Vermetten, Frewen, & Spiegel, 2012; Lanius et al, 2010). In addition, PTSD symptoms such as flashbacks and trauma-related amnesia are regarded by many theorists as dissociative phenomena (Dell, 2006b; Frewen & Lanius, 2015; Nijenhuis, Hart, & Steele, 2010).…”